Abstract
Aim: Assess healing pattern of Achilles tendons across gap created by percutaneous tenotomy and maintained by cast in club feet.
Methods and Results: 21 tenotomies in 16 patients (Age range 12 weeks–36 months) were monitored with dynamic and static ultrasonographic studies. Ultrasounds performed before, immediately after and at approximately 3, 6, 12 weeks post tenotomy. Cast removal was done at 3 weeks. Two patients above age of two were casted for 6 weeks.
The healing pattern went through different phases although they were not distinctively exclusive from each other and did show considerable overlap. First phase showed formation of bulbous mass with some continuity of scar tissue across tendon gap. The transition zone between new fibre and the original tend quite distinct. However dynamic ultrasound showed the Achilles tendon moved as a single unit. Second phase showed fibres resembling normal tendon crossing the gap and reduction of bulbous mass. The transition zone was still discernible. Final stage demonstrated more homogenous fibres of Achilles tendon with an indistinct transition zone. Two older children showed a distinctly longer process of healing.
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At 3 weeks there was no evidence of healing.
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At 6 weeks an irregular mass of fluid and soft tissue structures was seen.
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At 12 weeks there was evidence of continuation of tendon fibres, but transition zone partly visible.
Conclusion: Young Child (< 1 Year): When cast immobilisation is discontinued, the tendon is in mid phase of healing. There may be a positive effect on continued improvement in dorsiflexion while using boots and bars.
Older Child-Safe to consider percutaneous tenotomy in children up to 3 years of ages provided the period of immobilisation is extended.
Correspondence should be addressed to BSCOS c/o BOA, at the Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London, WC2A 3PE, England.
